The American Journal Of Emergency Medicine[JOURNAL]
Sun
200 papers
Association between prehospital time and trauma outcomes: A multicenter cohort study from the Pan-Asian Trauma Outcomes Study (PATOS).
Usawasuraiin P, Angkurawaranon C, Tangsuwanaruk T … +8 more , Aramrat C, Meelarp N, Wiwatkunupakarn N, Sairai R, Shin SD, Chiang WC, Tianwibool P, PATOS Participating Organizations
Am J Emerg Med · 2026 Aug · PMID 42114384 · Publisher ↗
BACKGROUND: Prehospital time is a critical determinant of trauma outcomes, yet its optimal duration remains unclear. OBJECTIVES: To summarize the patterns of prehospital time across countries and determine the associatio...
BACKGROUND: Prehospital time is a critical determinant of trauma outcomes, yet its optimal duration remains unclear. OBJECTIVES: To summarize the patterns of prehospital time across countries and determine the association between prehospital time and mortality in trauma patients. METHODS: We conducted a cross-national, multicenter retrospective cohort study of trauma patients who received EMS care and were ground-transported to hospitals between January 2019 and December 2022 using the Pan-Asia Trauma Outcomes Study (PATOS) database. Prehospital time was categorized into response time (RT), on-scene time (OST), transport time (TT), and total prehospital time (TPT). Outcomes were in-hospital mortality and poor functional outcome. Multivariable logistic regression adjusted for confounders, with subgroup analysis by injury mechanism. RESULTS: A total of 8968 patients from Taiwan, Malaysia, Korea, and Thailand were included; 376 (4.2%) died in hospital. Mean RT, OST, TT, and TPT were 16.2, 9.6, 9.9, and 35.7 min, respectively. Longer RT (adjusted odds ratio [aOR] 1.03, 95% CI 1.01-1.04) and OST (aOR 1.03, 95% CI 1.02-1.05) were independently associated with increased in-hospital mortality, whereas TT was not. Prolonged OST and TT were associated with poor functional outcomes. Among patients with traffic-related injuries, longer RT and OST remained significantly associated with mortality. CONCLUSION: Prehospital time varies across EMS systems. Prolonged RT and OST were associated with increased mortality, while extended OST and TT were associated with poor functional outcomes. However, these associations may reflect more severely ill patients requiring additional care.
Pediatric secondary transports within a regional emergency medical services system.
Ramgopal S, Janofsky SJ, Gorski JK … +5 more , Macy ML, Michelson KA, Horvat CM, Cash RE, Martin-Gill C
Am J Emerg Med · 2026 Aug · PMID 42114383 · Publisher ↗
OBJECTIVE: Secondary transport, defined as transferring a patient to a different hospital after initial EMS transport and hospital evaluation, is increasingly used in the care of ill and injured children. We described pe...
OBJECTIVE: Secondary transport, defined as transferring a patient to a different hospital after initial EMS transport and hospital evaluation, is increasingly used in the care of ill and injured children. We described pediatric secondary transport within a regional EMS system, identified prehospital factors associated with its use, and characterized children meeting established higher level of care criteria. METHODS: We performed a multi-EMS agency and multicenter study of pediatric transports from scene to one of 17 hospitals within an integrated health system. We described the longitudinal movement of encounters from the initial prehospital contact, the initial ED visit, and secondary transport and used a generalized linear mixed model to characterize factors associated with secondary transport. We identified the number of encounters meeting consensus criteria for requiring a higher level of care. RESULTS: We included 68,890 pediatric EMS transports (median age 7.8 years [IQR 2.2-14.5]). Of the 21,879 (31.8%) evaluated in a non-pediatric community or tertiary hospital, secondary transport occurred in 6.3%. Older children had lower odds of secondary transport (ORs 0.74-0.84). Secondary transport was more common with neurologic (1.44, 95% CI 1.16-1.78), respiratory (1.52, 95% CI 1.19-1.95), toxicology/ingestion (3.26, 95% CI 2.44-4.36), and psychiatric encounters (4.99, 95% CI 3.91-6.36) relative to trauma; occurred more when there was greater distance to the children's hospital; and occurred more in children with abnormal vital signs or impaired consciousness. Overall, 6.0% of encounters met at least one criterion requiring a higher level of care. The most common criteria met were the use of one of the medications in the Pediatric Advanced Life Support guideline (2.8% of all encounters), and airway management (1.6%). CONCLUSIONS: Approximately 6% of children evaluated at non-pediatric hospitals underwent secondary transport, particularly those with neurologic, respiratory, psychiatric, or toxicologic conditions. One-fifth who met higher-level care criteria were transported, underscoring the need to refine criteria, improve EMS triage, and develop standardized decision support.
Is an ED discharge safe after a single cardiac troponin: Analysis of the FAST-TRAC study.
Peacock WF, Mueller C, Anker SD … +13 more , Apple FS, Christenson RH, Daniels LB, Diercks DB, Di Somma S, Filippatos G, Headden G, Hiestand B, Hollander JE, Kosowsky JM, Vilke GM, Than M, Budd J
Am J Emerg Med · 2026 Aug · PMID 42114382 · Publisher ↗
BACKGROUND: Serial Highly Sensitive Cardiac Troponin I (hscTnI) measures are commonly performed in patients presenting to the ED to exclude suspected Acute Myocardial Infarction (AMI). The previously published FAST-TRAC...
BACKGROUND: Serial Highly Sensitive Cardiac Troponin I (hscTnI) measures are commonly performed in patients presenting to the ED to exclude suspected Acute Myocardial Infarction (AMI). The previously published FAST-TRAC study prospectively enrolled patients presenting to the ED within 6 h of onset of symptoms consistent with suspected AMI. Our purpose was to evaluate the performance of a single hscTnI measurement, termed "one-and-done" using this cohort. METHODS: In emergency department suspected acute coronary syndrome patients, serial blood samples were prospectively obtained for blinded hscTnI measurement (Access TnI, Beckman Coulter, Brea, CA) at 1, 2, 3-4, and 6-12 h after presentation. Patients were followed for 30-day Major Adverse Cardiac Events (MACE) determined by adjudicators blinded to hsTnI results. RESULTS: Of 1520 patients enrolled, 113 (7.4%) were adjudicated as AMI, with 59% male, median (IQR: Interquartile Rank) age of 57 years (48-67), 66% White, 28% African American, and 3% Asian American. The overall median (IQR) time to first hscTnI draw after symptom onset was 3.67 (2.50-5.09) hours. Serial hscTnI and one-and-done strategies had comparable C-statistics for AMI; 0.95 (0.93-0.98) vs 0.93 (0.91-0.96), respectively. In no circumstance did the 99th percentile cutpoint meet an adequate rule-out AMI sensitivity of 99%. Serial measures using either the 10% or 20% Coefficient of Variation (CV) Level of Quantification (LOQ) cutpoint had the same sensitivity of 99.1%, but the 10% CV LOQ had higher specificity, 61.7%, (95% CI = 59.1-64.2). For a "one-and-done" strategy, only the 20% CV LOQ, with a sensitivity of 99.1 (95.2-99.8), met the 99% sensitivity goal. Using the 20% CV LOQ, a "one-and-done" strategy would have immediately ruled out 39% (n = 550) of patients for AMI, with only 61% (n = 857) requiring additional serial hscTnI testing. CONCLUSIONS: A "one-and-done" strategy using a hscTnI <20% CV LOQ provides the most efficient AMI rule-out performance. REGISTRATION: NCT00880802.
Etiology-specific predictors for short-term functional outcomes of OHCA: A Japanese Nationwide registry study.
Hanada S, Nakai M, Koyama S … +6 more , Iwakiri H, Kaikita K, Yonemoto N, Matoba T, Tahara Y, Japanese Circulation Society with Resuscitation Science Study (JCS-ReSS) Investigators
Am J Emerg Med · 2026 Aug · PMID 42105435 · Publisher ↗
BACKGROUND: Out-of-hospital cardiac arrest (OHCA) functional outcomes vary widely by etiology, but cerebrovascular-origin OHCA remains poorly characterized. This study aimed to identify etiology-specific predictors of fa...
BACKGROUND: Out-of-hospital cardiac arrest (OHCA) functional outcomes vary widely by etiology, but cerebrovascular-origin OHCA remains poorly characterized. This study aimed to identify etiology-specific predictors of favorable functional outcomes after OHCA using a nationwide Japanese registry. METHODS: We analyzed 392,770 adult OHCA cases (311,632 cardiac-origin and 81,138 cerebrovascular-origin) recorded between 2005 and 2023 using data from the All-Japan Utstein Registry, a prospective nationwide population-based registry. Favorable outcome was defined as CPC 1-2 and OPC 1-2 at 30 days. Demographic, clinical, and time variables were evaluated using multivariable logistic regression. Missing time data were treated as an "unknown" category. A sensitivity analysis using Firth's penalized likelihood regression was performed on subgroups with recorded time data. RESULTS: Favorable outcomes were observed in 9.7% of cardiac-origin and 2.5% of cerebrovascular-origin OHCA. In cardiac-origin OHCA, early defibrillation (<5 min) was a strong predictor. Cerebrovascular OHCA showed a negligible association with age (OR 1.00, 95% CI 0.99-1.00), and defibrillation at 5-10 min was paradoxically associated with better outcomes. Time to ROSC >15 min was consistently associated with poor outcomes in both groups. Crucially, the sensitivity analysis demonstrated that the paradoxical associations were no longer statistically significant after applying Firth's correction. CONCLUSIONS: Determinants of favorable outcomes may differ fundamentally. The findings suggest that prognosis after cerebrovascular-origin OHCA may be largely influenced by the initial severity of cerebral injury, rather than by the timing of prehospital resuscitation efforts. However, given the limitation of registry-based research, prospective studies are warranted to confirm these observations.
Psychologists in emergency care: Burnout prevention and intervention.
Töreki A, Kórizs T, Tóth GD … +1 more , Pető Z
Am J Emerg Med · 2026 Sep · PMID 42103490 · Publisher ↗
Abstract loading — click title to view on PubMed.
Triage administration of sucrose for gastroenteritis in children; a randomized controlled trial.
Péloquin F, Thibault X, Mousseau S … +3 more , Weill O, D'Astous SR, Gravel J
Am J Emerg Med · 2026 Aug · PMID 42102507 · Publisher ↗
OBJECTIVES: Gastroenteritis is a common reason for pediatric emergency department (ED) visits. Fasting-induced ketosis has been proposed as a contributing factor that may exacerbate vomiting. We evaluated whether adminis...
OBJECTIVES: Gastroenteritis is a common reason for pediatric emergency department (ED) visits. Fasting-induced ketosis has been proposed as a contributing factor that may exacerbate vomiting. We evaluated whether administration of a concentrated sucrose solution improves oral intake. METHODS: We conducted a double-blind randomized controlled trial in a tertiary pediatric ED (2022-2024). Children aged 6 months to 7 years with vomiting most likely due to gastroenteritis were enrolled. Participants received a single dose of either sucrose solution (1.5 mL/kg, 3.5 g of sucrose/10 mL), or diluted juice alone (0.5 g of sucrose/10 mL), followed by oral rehydration therapy. The primary outcome was the volume of rehydration solution ingested (mL) within the first 2 h. Secondary outcomes included vomiting episodes, ondansetron use, return visits, and intravenous rehydration. RESULTS: Of 2001 children screened, 240 (12.0%) were eligible and enrolled; 208 (92%) had primary outcome data. Participants were randomized to the sucrose group (n = 111) or the placebo group (n = 116). There was no significant difference in the volume of rehydration solution ingested between groups (84 mL vs 95 mL; mean difference - 11 mL; 95% CI -26 to 4). There were also no significant differences in the mean number of vomiting episodes (0.46 vs 0.47), intravenous rehydration (14% vs 12%), return visits (5% vs 4%) or ondansetron use (70% vs 68%). CONCLUSION: A single dose of sucrose solution does not improve oral rehydration intake in children with gastroenteritis in the ED.
Extended-Release Buprenorphine Administration by Emergency Medical Services Paramedics: A Case Series.
Comber P, Haroz R, Heil J … +1 more , Carroll G
Am J Emerg Med · 2026 Aug · PMID 42096946 · Publisher ↗
BACKGROUND: Medications for opioid use disorder (MOUD), including buprenorphine, reduce mortality and improve treatment retention. However, daily sublingual formulations may be impractical for patients with unstable hous...
BACKGROUND: Medications for opioid use disorder (MOUD), including buprenorphine, reduce mortality and improve treatment retention. However, daily sublingual formulations may be impractical for patients with unstable housing, limited healthcare access, or interrupted care. Extended-release buprenorphine (XR-BUP) provides sustained therapeutic levels without daily dosing and may overcome barriers to adherence. Emergency Medical Services (EMS), both 911 and Mobile Integrated Healthcare (MIH) models, are uniquely positioned to initiate or maintain MOUD among high-risk individuals in community settings. The purpose of this case series is to describe EMS clinicians administering XR-BUP to individuals with opioid use disorder (OUD) in a 911-based system. METHODS: We report three cases of paramedic initiated XR-BUP administration in a 911-based EMS system in Southern New Jersey between July and September 2025. Patients were selected based on OUD severity, EMS utilization, and inability to access consistent outpatient treatment. EMS paramedics initiated and administered XR-BUP via physician-directed protocols. Patients were followed longitudinally after EMS administered XR-BUP. RESULTS: EMS successfully administered XR-BUP in all three cases without precipitated withdrawal or adverse events. All patients demonstrated improved engagement with addiction care. EMS treatment enabled continuity of treatment and bridged treatment gaps in traditional healthcare access. CONCLUSION: EMS-facilitated XR-BUP administration is feasible and may represent an innovative strategy to initiate and sustain MOUD among high-risk populations. EMS systems, both 911 and MIH, may serve as effective platforms for delivering long-acting buprenorphine and improving treatment access and adherence. Further research is needed to evaluate safety, scalability, and long-term outcomes.
Assessing the impact of the implementation of a remediation and teaching tool on error rate.
Lewis JJ, Eshraghi N, Marks C … +3 more , Burstein JL, Grossestreuer AV, Grossman SA
Am J Emerg Med · 2026 Aug · PMID 42091021 · Publisher ↗
BACKGROUND: Effective Quality Assurance/Improvement (QA/QI) remediates and educates physicians, aiming to address past adverse events and guard against similar errors. Limiting future error requires understanding how dif...
BACKGROUND: Effective Quality Assurance/Improvement (QA/QI) remediates and educates physicians, aiming to address past adverse events and guard against similar errors. Limiting future error requires understanding how different educational methods work. The objective of this study was to assess the impact of QI discussion and teaching slides during Morbidity and Mortality (M&M) rounds on subsequent error. METHODS: This was a retrospective study of all QA-reviewed cases between 2015 and 2022 at a tertiary-care, academic ED. Starting in 2019, QI slides addressing recent errors were presented and discussed during weekly M&Ms. To assess education efficacy, errors from 2015 to 2018 (no slides) were compared to those from 2019 to 2022 (teaching slides). Cases with an error were reviewed to determine if the error was primarily attributable to the attending or resident and then classified and compared by five categories: not acquiring necessary information, not acting on data acquired, knowledge gaps, communication gaps, and systems issues. RESULTS: There was no significant difference in overall error rate by attending or resident after the implementation of QI slides (attending: 2.5% pre vs 2.1% post; risk difference: -0.4% [95% CI: -1.0%-0.1%, p = 0.107], resident: 0.9% pre vs 1.2% post; risk difference: 0.2% [95% CI: -0.1%-0.6%, p = 0.229]). When evaluating by specific error category, there was a decrease in "not acquiring necessary information" by attendings only (0.6% pre vs 0.3% post; risk difference: -0.3% [95% CI: -0.5%, -0.1%, p = 0.006]). CONCLUSIONS: Implementing QI teaching slides did not significantly impact the total number of errors by attendings or residents but may lower the risk of attendings not acquiring certain key information. Future studies on directed feedback for attending and resident errors may elucidate their full educational impact.
Predictors and economic impact of potentially avoidable transfers in facial fractures among pediatric populations: A 15-year analysis.
Cheng LG, Liu SX, Dhariwal A … +9 more , Glenney AE, Ocasio-Nieves B, Somorin T, Kass NM, Dvoracek LA, David JA, Kueper J, Saladino RA, Goldstein JA
Am J Emerg Med · 2026 Aug · PMID 42085947 · Publisher ↗
BACKGROUND: Transfers of children with minor injuries, rather than complex trauma requiring specialized care, create unnecessary strain on patients, families, and healthcare resources. While existing research has examine...
BACKGROUND: Transfers of children with minor injuries, rather than complex trauma requiring specialized care, create unnecessary strain on patients, families, and healthcare resources. While existing research has examined transfers for specific injury categories, our study comprehensively investigates the factors driving potentially avoidable transfers (PATs) among pediatric patients with diverse facial fracture presentations, as well as the economic impact associated with these transfers. METHODS: A retrospective analysis examined facial fractures in pediatric patients at our level I pediatric trauma center from 2006 to 2021. We defined Potentially Avoidable Transfers (PATs) as cases with hospital stays under 24 h, no admission, no surgery, and no emergency or specialized procedures post-transfer. We analyzed demographics, medical history, injury characteristics, associated injuries, treatments, and outcomes using logistic regression, chi-square, or Fisher's exact tests in Stata SE Software (Version 17.0, College Station, TX). RESULTS: Of 3334 pediatric patients identified, 3132 patients met inclusion criteria; of these, 1251 (40.1%) were transferred from a community hospital and 297 (23.7%) met our definition of a PAT. Potentially avoidable transfers were predominantly male (n = 217, 73.1%) and 11 years of age on average. Key patient characteristics associated with PAT were lack of medical insurance (p = 0.004, OR = 1.83), age less than six years age (p = 0.007, OR = 1.98), and the presence of an orbital or mandible fracture (p = 0.001, OR = 1.83). A single PAT incurred a cost of $2125.90 at the receiving hospital, with most expenses resulting from imaging and laboratory tests. CONCLUSIONS: PATs impose substantial logistical and economic challenges for patients and healthcare systems. We propose developing transfer protocols to enhance clinical decision-making, potentially reducing unnecessary transfers while ensuring patient safety. Remote specialist consultation for pediatric patients could also optimize care by minimizing unwarranted transfers.
Response to reader comment regarding "Impact of hemodialysis timing on survival in paraquat poisoning".
Benito-León J, Singh AK, Biswas U … +3 more , Ghosh R, Sohrab A, Bhattacharjee A
Am J Emerg Med · 2026 Aug · PMID 42067435 · Publisher ↗
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A 25-year analysis of Armillaria (honey mushroom) poisoning in Wisconsin.
Feldman R, Audette M, Leacock PR … +1 more , Theobald J
Am J Emerg Med · 2026 Aug · PMID 42066652 · Publisher ↗
BACKGROUND: Wild mushroom foraging is common in the United States. Poisoning usually results from misidentification, though some "edible" mushrooms can also cause toxicity. Armillaria ("honey mushrooms") are widely forag...
BACKGROUND: Wild mushroom foraging is common in the United States. Poisoning usually results from misidentification, though some "edible" mushrooms can also cause toxicity. Armillaria ("honey mushrooms") are widely foraged and generally considered edible, yet sporadic gastrointestinal illness has been reported. Their clinical effects remain poorly described. Poison center data provide real-world exposure characterization with standardized symptom documentation and mycologist collaboration. This study characterized the presentation, management, and outcomes of suspected or confirmed Armillaria ingestions reported to the Wisconsin Poison Center (WPC) over 25 years. METHODS: We conducted a retrospective case series of WPC records (2000-2025). Cases coded as Armillaria, "unknown mushroom," or "gastrointestinal irritant mushroom" were screened. Inclusion required mycologist confirmation or patient-reported Armillaria ingestion. RESULTS: Eighteen cases were identified; 50% (n = 9) had mycologist confirmation. Exposures occurred August-October, with 78% in late September-mid-October. Most patients were adults (94%), median age 41.5 years. Fifteen (83%) developed gastrointestinal symptoms (vomiting, diarrhea, abdominal pain, nausea); all symptomatic patients had vomiting or diarrhea. Three (17%) remained asymptomatic. Symptom onset ranged 0.25-7.5 h (median 3.5), with resolution in 2-41 h (median 8.75). Five patients (28%) were evaluated in an emergency department; four were discharged and one had a brief admission for symptom control. No organ failure or deaths occurred. Illness occurred despite reported cooking. Concern for misidentification with toxic look-alikes was common; some cases reporting Armillaria were later identified as psilocybin-containing Gymnopilus. CONCLUSIONS: Armillaria ingestion produces a self-limited gastrointestinal toxidrome, typically with early onset but occasionally >6 h, which may complicate differentiation from amatoxin-containing species such as Galerina. If patients report Armillaria ingestion toxic look-alikes, including Gymnopilus, Galerina, Cortinarius, and muscarine-containing genera, should remain in the differential if appropriate toxidrome features are present. Confirmed cases generally have a favorable prognosis. Early poison center or toxicology consultation can assist with identification and management.
Comparison of three point-of-care ultrasound techniques to confirm endotracheal tube placement: A randomized clinical trial.
Kudu E, Korgan MB, Altun M … +5 more , Yakin F, Karacabey S, Sanri E, Akoglu H, Denizbasi A
Am J Emerg Med · 2026 Aug · PMID 42066651 · Publisher ↗
BACKGROUND: Rapid confirmation of the endotracheal tube (ETT) position following emergency intubation is crucial, but traditional methods have limitations in this setting. Although ultrasonographic techniques are highly...
BACKGROUND: Rapid confirmation of the endotracheal tube (ETT) position following emergency intubation is crucial, but traditional methods have limitations in this setting. Although ultrasonographic techniques are highly accurate, studies comparing them are limited. In this study, we aimed to compare the diagnostic performance and speed of three different point-of-care ultrasound (POCUS) techniques for confirming ETT position. METHODS: We conducted a single-center, prospective, randomized clinical trial in the emergency department of a university hospital. Adults undergoing rapid sequence intubation were randomly assigned to transtracheal ultrasound (TUS), lung-sliding ultrasound (LUS), or diaphragm ultrasound (DUS) with 1:1:1 allocation ratio. The primary outcome was ETT location (tracheal or esophageal), determined by waveform capnography and auscultation. We also measured intubation time and the time needed for each confirmation method. RESULTS: Of 217 patients screened, 200 were randomized to TUS (n = 66), LUS (n = 67), or DUS (n = 67), and all were included in the primary analysis. The median age was 75 years (IQR 63-84), and 54.5% were male. Esophageal intubation occurred in 14% (n = 28) of patients. For tracheal placement detection, sensitivity and specificity were 98.2% (95% CI, 90.4% to 100.0%) and 100.0% (95% CI, 69.2% to 100.0%) for TUS, 98.2% (95% CI, 90.6% to 100.0%) and 100.0% (95% CI, 69.2% to 100.0%) for LUS, and 96.6% (95% CI, 88.3% to 99.6%) and 87.5% (95% CI, 47.3% to 99.7%) for DUS, with no between-group difference in accuracy (p = 0.44). Confirmation times were 4.6 s (IQR, 3.3-6.0) for TUS, 9.4 s (IQR, 7.3-12.2) for LUS, and 13.4 s (IQR, 11.8-15.1) for DUS (p < 0.001). Auscultation took a median of 11.5 s (IQR 9.4-13.9), and obtaining five capnography waveforms took 17.0 s (IQR 14.2-20.6). CONCLUSION: All three ultrasound techniques demonstrated high diagnostic performance for confirming ETT location after rapid sequence intubation, with TUS providing the shortest confirmation time. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT06656546.
Alcoholic cardiomyopathy presenting with severe circulatory failure requiring mechanical circulatory support: A systematic review.
Itagaki H, Endo T
Am J Emerg Med · 2026 Aug · PMID 42066650 · Publisher ↗
BACKGROUND: Alcoholic cardiomyopathy (ACM) is a potentially reversible form of dilated cardiomyopathy associated with chronic excessive alcohol consumption. Although recovery of left ventricular function after alcohol ab...
BACKGROUND: Alcoholic cardiomyopathy (ACM) is a potentially reversible form of dilated cardiomyopathy associated with chronic excessive alcohol consumption. Although recovery of left ventricular function after alcohol abstinence has been reported, the clinical course of patients presenting with cardiogenic shock or cardiac arrest requiring mechanical circulatory support (MCS) remains poorly characterized. This study aimed to evaluate survival outcomes and myocardial recovery in patients with ACM presenting with severe circulatory failure. METHODS: A systematic literature search was conducted in PubMed, Web of Science, Google Scholar, and Ichushi-Web from database inception to February 28, 2026. Studies describing patients with ACM presenting with cardiogenic shock or severe circulatory failure requiring temporary MCS (including ECMO, Impella, intra-aortic balloon pump, or LVAD) were included. Extracted data included patient characteristics, type of circulatory support, survival outcomes, and recovery of left ventricular function. RESULTS: Five studies (three case reports and two case series), including 10 patients, were identified. The median age was 43 years (IQR, 38-46), and 9 of 10 patients (90%) were male. The median baseline LVEF was 15% (IQR, 15-20%). Cardiac arrest occurred in 3 patients (30%). Veno-arterial extracorporeal support, including VA-ECMO/PCPS, was used in 9 patients (90%), Impella in 1 patient (10%), and LVAD support in 3 patients (30%). One patient ultimately underwent heart transplantation. All published cases survived. Among patients with available follow-up data, the median LVEF improved to 55% (IQR, 45-60%), representing a median absolute increase of approximately 40 percentage points. CONCLUSIONS: Published case-based evidence suggests that alcoholic cardiomyopathy may retain clinically meaningful reversibility even in selected patients with severe circulatory failure requiring mechanical circulatory support. Although favorable outcomes may be overrepresented in published reports, awareness of this potentially reversible phenotype may support timely recognition and appropriate management of severe circulatory failure.
Trends in lumbar puncture utilization across a health system and in emergency department practice.
Wu D, Salah W, Thom C
Am J Emerg Med · 2026 Aug · PMID 42066649 · Publisher ↗
BACKGROUND: Lumbar puncture (LP) remains a core emergency department (ED) procedure, though recent trends suggest a shift toward non-ED specialties. Within ED practice, trends in LP indications and procedural success are...
BACKGROUND: Lumbar puncture (LP) remains a core emergency department (ED) procedure, though recent trends suggest a shift toward non-ED specialties. Within ED practice, trends in LP indications and procedural success are not well characterized. OBJECTIVES: To evaluate longitudinal trends in LP procedural volume across departments within a tertiary care health system and to characterize trends in ED LP indications, success rates, and variables associated with success. METHODS: We conducted a retrospective study at a single academic health system. LP volumes across clinical departments were assessed for calendar years (CYs) 2012-2024 using Poisson regression with incidence rate ratios (IRRs). ED-specific analyses included LPs performed from CYs 2014-2024, with temporal trends in indications evaluated using IRRs and multivariable logistic regression used to identify factors associated with LP success. RESULTS: Radiology performed the greatest number of LPs from 2012 to 2024, with a 4.4% annual increase (IRR 1.044, 95% CI 1.036-1.052). ED LP volume declined by 1.5% annually (IRR 0.985, 95% CI 0.972-0.999). A total of 1117 LPs were performed in the ED from 2014 to 2024 (mean 106 annually), with success decreasing from 93.1% to 76.3%. LPs for subarachnoid hemorrhage declined (IRR 0.78/year, p < 0.001), while those for idiopathic intracranial hypertension (IIH) increased (IRR 1.29/year, p < 0.001). Upright positioning was independently associated with higher odds of success compared with lateral decubitus (OR 2.2, 95% CI 1.2-4.0). CONCLUSION: LP volume shifted toward non-ED specialties, particularly Radiology, Internal Medicine, and Pediatrics. Within ED LP practice, indications shifted toward IIH and upright positioning was associated with greater LP procedural success.
Analysis of risk factors for concurrent osteomyelitis in children with septic arthritis: A retrospective cohort study.
Wang C, Wang K, Zhu H … +3 more , Zou Y, Tian Y, Xu W
Am J Emerg Med · 2026 Aug · PMID 42061203 · Publisher ↗
BACKGROUND: The early differentiation of septic arthritis (SA) with concomitant osteomyelitis (OM) from isolated SA is a critical diagnostic challenge in pediatric orthopedics. This study aimed to identify clinical and l...
BACKGROUND: The early differentiation of septic arthritis (SA) with concomitant osteomyelitis (OM) from isolated SA is a critical diagnostic challenge in pediatric orthopedics. This study aimed to identify clinical and laboratory risk factors for concurrent OM in children with SA. METHODS: We conducted a retrospective cohort study of 132 children surgically treated for SA at our institution between January 2016 and December 2023. Patients were dichotomized into two groups: isolated SA (n = 66) and SA with concurrent OM (SA + OM, n = 66). We collected demographic, clinical, and laboratory data, including time from symptom onset to admission and surgery, time from admission to surgery, prior parenteral antibiotic use, presence of septic shock, preoperative maximum temperature, and microbiological findings. Univariable analyses were performed using Chi-square tests, Mann-Whitney U tests, or independent t-tests. Variables with statistical significance were entered into a multivariable logistic regression model to identify independent predictors of concurrent OM. RESULTS: Univariable analysis revealed significant differences between the isolated SA and SA + OM groups in time from onset to admission (4.98 ± 2.88 vs. 6.21 ± 3.32 days, P = 0.029), time from onset to surgery (5.50 ± 3.41 vs. 8.02 ± 6.56 days, P = 0.007), time from admission to surgery (12.5 ± 6.8 vs. 43.5 ± 12.4 h, P < 0.001), presence of septic shock (3.0% vs. 12.1%, P = 0.048), preoperative maximum temperature (38.9 ± 0.70 vs. 39.20 ± 0.68 °C, P = 0.008), and infection with Staphylococcus aureus (21.2% vs. 43.9%, P = 0.005). After multivariable logistic regression analysis, three independent risk factors for concurrent OM were identified: time from onset to surgery >7.5 days (Adjusted Odds Ratio [aOR] 3.96, 95% Confidence Interval [CI] 1.07-14.69; P = 0.039), preoperative maximum temperature > 38.65 °C (aOR 3.43, 95% CI 1.46-8.07; P = 0.005), and infection with S. aureus (aOR 3.17, 95% CI 1.38-7.27; P = 0.007). CONCLUSION: Delayed surgical intervention (>7.5 days from onset), high preoperative fever (>38.65 °C), and infection with S. aureus are significant independent predictors of concurrent osteomyelitis in children with septic arthritis. Clinicians should maintain a high index of suspicion for OM in patients presenting with these risk factors and consider advanced imaging to guide appropriate surgical management.
Impact of aspirin use on the modified brain injury guidelines for the management of mild traumatic intracranial hemorrhage.
Nene RV, Simon N, Smith AM … +2 more , Costantini TW, Haines LN
Am J Emerg Med · 2026 Aug · PMID 42061202 · Publisher ↗
STUDY OBJECTIVE: The purpose of this study was to determine if pre-injury aspirin use increases the risk of deterioration in isolated mild traumatic intracranial hemorrhage (tICH) patients who might otherwise be safely m...
STUDY OBJECTIVE: The purpose of this study was to determine if pre-injury aspirin use increases the risk of deterioration in isolated mild traumatic intracranial hemorrhage (tICH) patients who might otherwise be safely managed without transfer to a tertiary trauma center. METHODS: This was a retrospective observational analysis of isolated mild tICH patients who were transferred to a regional Level I Trauma Center between 2018 and 2023. Data abstracted from the trauma registry and electronic medical record included patient presentation, management, and outcomes. Patients were risk-stratified according to the modified Brain Injury Guidelines (mBIG) criteria, with a new fourth category, mBIG1-asa, which was defined as patients on aspirin who would otherwise be classified as mBIG1. RESULTS: There were 575 patients with isolated mild tICH transferred to the Level I Trauma Center. Median age was 73 years, and fall was the most common mechanism of injury (74.1%). 78 patients (13.6%) were classified as mBIG1, and 47 (8.2%) were classified as mBIG1-asa. No patients in either mBIG1 or mBIG1-asa required neurosurgical intervention or died. One mBIG1-asa patient with a subarachnoid hemorrhage developed a new small focus of hemorrhage on repeat head imaging, however remained minimally symptomatic and was discharged home 4 days later after a brief ICU stay. CONCLUSION: We propose that the mBIG1 criteria may be expanded to include patients on pre-injury aspirin. Further prospective studies are necessary to demonstrate that these patients may be safely observed without transfer to a regional trauma center.
EMS protocol gaps for defibrillator pad placement in prehospital STEMI care.
Packel C, Costa S, Flamm A
Am J Emerg Med · 2026 Aug · PMID 42061201 · Publisher ↗
BACKGROUND: Patients experiencing ST-segment elevation myocardial infarction (STEMI) face a significant risk of sudden cardiac arrest (SCA) in the prehospital setting, often presenting as shockable rhythms. Early defibri...
BACKGROUND: Patients experiencing ST-segment elevation myocardial infarction (STEMI) face a significant risk of sudden cardiac arrest (SCA) in the prehospital setting, often presenting as shockable rhythms. Early defibrillation is critical to survival, and preemptive placement of defibrillator pads may reduce time to shock. However, the extent to which EMS protocols recommend this practice remains unclear. OBJECTIVE: To assess the prevalence and specificity of guidance on defibrillator pad placement for STEMI patients in U.S. EMS protocols and identify gaps in prehospital care. METHODS: We conducted a cross-sectional review of 30 publicly available state-wide EMS protocols or recommendations. We analyzed Protocols for recommendations on defibrillator pad placement during STEMI transport, ECG acquisition timing, and hospital notification. Findings were summarized using descriptive statistics. RESULTS: Only 13% of protocols explicitly advised placing defibrillator pads on STEMI patients during transport, while 17% suggested considering pad placement. The remaining 70% provided no guidance. Few protocols specified ECG acquisition timing goals (33%), though 67% emphasized early STEMI notification to receiving hospital. CONCLUSIONS: EMS protocol guidance on defibrillator pad placement for STEMI patients remains limited and variable. Most protocols lack clear recommendations, potentially delaying rapid defibrillation during cardiac arrest. Further research should assess the clinical impact, cost-effectiveness, and implementation barriers of routine preemptive pad placement during STEMI transport.
Practice changing articles: Multidose ondansetron after emergency visits in children with gastroenteritis.
Pourmand A, Gottlieb M, Bridwell RE … +1 more , Long B
Am J Emerg Med · 2026 Aug · PMID 42055827 · Publisher ↗
Abstract loading — click title to view on PubMed.
A simple instrument-ring technique for rapid localization of scalp bleeding in the emergency department.
Halhalli HC, Celik E
Am J Emerg Med · 2026 Sep · PMID 42055826 · Publisher ↗
Abstract loading — click title to view on PubMed.
Interfacility transfers to the emergency department via emergency medical services in the United States: A nationwide descriptive study and trend analysis.
Peters GA, Samadian KD, Awan SA … +6 more , Misra AJ, Chandran KG, Huang CK, Baugh JJ, Cash RE, Goldberg SA
Am J Emerg Med · 2026 Aug · PMID 42054773 · Publisher ↗
OBJECTIVE: We hypothesized: (1) the burden of emergency department (ED) resource utilization for interfacility transfer (IFT) patients is greater than for other ED patients, and (2) national rates of IFT to the ED have i...
OBJECTIVE: We hypothesized: (1) the burden of emergency department (ED) resource utilization for interfacility transfer (IFT) patients is greater than for other ED patients, and (2) national rates of IFT to the ED have increased over time. METHODS: We completed a retrospective cohort analysis using a nationally representative sample of ED visits during 2014-2022 and stratified by whether the patient arrived via IFT with emergency medical services (EMS). We described and compared patient characteristics and measures of emergency resource utilization between groups using appropriate survey sampling weights. We then assessed national trends in the annual proportion of ED visits arriving via IFT using a logistic regression model with three-year estimates. RESULTS: A weighted estimate of 1,213,596,152 ED visits (roughly 136 M annually) was included in this analysis. There were 11,802,738 (1.0%) ED visits that arrived via IFT, yielding an annual mean of 1.3 M per year. IFT patients were more often triaged ESI 1 and 2; had shorter wait times to be seen; received more diagnostic tests, medications, and procedures in the ED; and were more often hospitalized. Using three-year study periods, the proportion of IFT among ED visits increased by 15% during 2017-2019 and by 35% during 2020-2022 relative to the baseline period during 2014-2016. CONCLUSIONS: Our findings support the hypotheses that IFT patients consume a significantly higher volume of ED resources, and that the proportion of ED visits arriving via IFT has increased over time. Tertiary center EDs and EMS agencies should invest in improved preparedness for ED-ED IFT patients.
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